Introducing Chispa, DX 07/18/2022

[Karen and Chispa (GA)]

Hi everyone,

I'm new here and trying not to freak out while assimilating as much information as possible every day. My sweet girl Chispa (means "spark"in Spanish) was diagnosed on 7/18 with BG of 400. I'd been noticing over the past few months that she had been drinking a lot and her urine output had nearly doubled. She'll be 16 in September and has multiple issues, as you can see from my signature -- and yet despite all that, to look at her, you'd never know anything was "wrong." Her weight has remained stable on a diet of Hill's and Royal Canin prescription renal food (canned), which she loves -- she cleans her plate at every meal -- and her kidney values have also remained stable since being diagnosed with CKD stage 1 in October 2020.

Upon diagnosing her DM, the vet prescribed Lantus insulin, which I ordered; then Chispa and I returned to the clinic on Thursday for a demo on how to administer the starting dose of 1 unit. They retested her glucose and came up with a reading of 470, confirming that she needed insulin -- but for the demo, we practiced with sterile water, so she has not actually had her first insulin dose yet. It was only then that I understood I'd also need a glucometer, so I read the recommendations and am now totally confused by all of the options. My immediate question for today is whether to pick up a human glucometer and supplies from CVS and get started on the insulin today, or order a pet-specific and supposedly "pain-free" version online, which would mean waiting 2-3 days for it to arrive. Maybe I'm just stalling because I can't stand the thought of poking my baby's ear, which she clearly did not appreciate during the demo on Thursday. I asked the vet tech how much damage was being done to her internal organs every day while waiting for the insulin to arrive (which it did, yesterday) and was told that it was ok to wait a few days -- which is counter to what I've read so far on this forum.

Any advice for this terrified newbie would be most welcome!

With thanks,
Karen and Chispa

 

[Karen and Chispa (GA)]

One relevant fact that I forgot to mention: After reading about the importance of low-carb diets on this site, I've decided to transition Chispa from the prescription renal food she's been getting to a non-prescription food that seems to offer the best compromise of low carbs and a phosphorous level that is relatively low at 0.74% (though that's still higher than the <0.5% recommended for CKD cats). The food I've ordered (Weruva Truluxe "On the Cat Wok") should be arriving in a couple of days. I understand that consuming fewer carbs will lower Chispa's glucose level pretty quickly --- would that be a reason to hold off on beginning the glucose testing and administering of insulin until after starting her on the new food?

With thanks,
Karen and Chispa

 

[Red & Rover (GA)]

Chispa (great name!) has a lot going on. I'm tagging
@Wendy&Neko
who has handled similar multiple issues. Mainly it is the ICB in your signature that concerns me. What foods can Chispa not eat?

Some FYIs:
We were all terrified at the beginning. Welcome to the best place you never thought you would be.
And we were scared of poking a cat's ear repeatedly and some of us that cats that did not like it … at first.

There's a pain-free meter? I doubt it. If the meter uses lancets, then it's not pain-free. The good news is that a cat's ear does not have as many nerve endings as you might think. Think of how often the ears take a beating during a cat spat.
It could be that Chispa was reacting either to the vet office or the click of the lancet device near their ear (some people have better success freehanding the lancet).
Even the most stubborn of cat can come around to multiple testings throughout the day. A small low phos, low carb treat, or even a bit of cooked chicken works wonders.

Thank you for being on top of Crispa's conditions. And again, welcome. Waving from Canada.

 

[Red & Rover (GA)]

Also tagging @Sienne and Gabby (GA)

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

I would suggest getting a human meter. The strips are a fraction of the cost compared to a pet meter. Many people here use the Walmart Relion brand meter. The continuous glucose monitor (e.g., Freestyle Libre) involves a sensor that is glued to your cat's skin and lasts for 2 weeks. Kitties have a knack for getting the sensors off or they stop working in less than 2 weeks and they cost around $60. A human meter is the most economical. In addition, the strips for a human meter are available in stores. The strips for pet meters are not which means if you're running low, you could be in a tough situation.

The beginning of this process is overwhelming -- so you're exactly where you would expect to be! There's a ton of information about Lantus in the sticky notes at the top of the Lantus board. If you've not already looked at that information, it may be helpful.

Let us know what questions you have. Otherwise, we'll tend to add to your being overwhelmed with information.

 

[Diane Tyler's Mom GA]

Welcome Karen and Chispa
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar

I would also suggest a human meter that's what most of us use and our numbers are based on if you have a Walmart by you or you can even order on their site
The Relion Premier Classic 9 dollars
17.88 for 100 test strips
26 or 28 gauge lancets any brand
Cotton rounds

 

[Diane Tyler's Mom GA]

This was posted by one of our members about weruva foods you can find other flavors that are low carb and low phosphorus
With weruva foods
You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts.
https://weruva.com


When you go to the weruva site and click on one of the pic of the food , click on Detailed Nutrition information that is under guaranteed analysis to the left Detailed Nutrition Information Tap on that
YOU WANT CARBS UNDER 10% AND PHOSPHORUS IDEALLY LOW 200's OR LESS

Go to this thread , there are a lot of weruva foods listed here in post #3 , post numbers are to the left
https://felinediabetes.com/FDMB/threads/kidney-disease.262271/#post-2940026

 

[Karen and Chispa (GA)]

Thank you so very much, Red, Sienne, and Diane, for your kindness and helpful replies. I'm especially glad to know about the "sweet spot" on the ears, since I would have gone straight for the marginal vein as the most obvious target. Chispa thanks you for saving her from that mistake!

About the ICB (I'm assuming that's the same as IBD (?)): It was diagnosed in May 2021 by ultrasound, which the vet recommended for both of my cats because they had both been vomiting persistently for several months. Chispa and her (unrelated) brother, Chulo, had nearly identical findings on the ultrasound, with similar amounts of intestinal thickening in almost the same locations. The vet explained that it could be either IBD or SCL (small cell lymphoma), and the only way to know for sure would be a surgical biopsy (endoscopic not possible because of location). After consulting with two other vets (long story), I opted not to do the biopsies. We attempted to do an elimination diet trial, but they wouldn't touch the special food, so both cats were started on prednisolone. Chispa began to improve almost immediately, but while she gained weight and generally thrived, Chulo continued to vomit several times a week. We started him on chlorambucil in July, and his symptoms improved marginally over the next few months, but his coat looked nappy and he never regained the weight he had lost. The reason became clear in late November, when the vet found an oral squamous cell carcinoma under his tongue. He was euthanized on 12/7/2021, shattering our hearts into a million pieces. So it's been a rough year.

The good news for Chispa is that her IBD has been completely controlled with 5mg/day of prednisolone. Her weight has stayed consistent (she actually got too plump at one point), and I can't even remember the last time she vomited. The prescription renal diet seems to agree with her, but I know now that it's too high in carbs for a diabetic kitty. I'm hoping that she will be ok with the change in diet, especially since we've reduced her pred to 2.5mg/day.

I'll run up to CVS tomorrow morning and pick up the human glucometer and supplies. I'm just terrified of reducing her BG too much with the insulin once we switch to the lower-carb diet. So again, is it better to start the insulin immediately, then transition her diet -- or switch to the low-carb food first, then re-test in a week or so, before starting the insulin? I'll email the vet with this question as well, but she works Tues - Fri, so I won't get an answer for a few days.

Many thanks again,
Karen and Chispa

 

[Diane Tyler's Mom GA]

Thank you so very much, Red, Sienne, and Diane, for your kindness and helpful replies. I'm especially glad to know about the "sweet spot" on the ears, since I would have gone straight for the marginal vein as the most obvious target. Chispa thanks you for saving her from that mistake!

About the ICB (I'm assuming that's the same as IBD (?)): It was diagnosed in May 2021 by ultrasound, which the vet recommended for both of my cats because they had both been vomiting persistently for several months. Chispa and her (unrelated) brother, Chulo, had nearly identical findings on the ultrasound, with similar amounts of intestinal thickening in almost the same locations. The vet explained that it could be either IBD or SCL (small cell lymphoma), and the only way to know for sure would be a surgical biopsy (endoscopic not possible because of location). After consulting with two other vets (long story), I opted not to do the biopsies. We attempted to do an elimination diet trial, but they wouldn't touch the special food, so both cats were started on prednisolone. Chispa began to improve almost immediately, but while she gained weight and generally thrived, Chulo continued to vomit several times a week. We started him on chlorambucil in July, and his symptoms improved marginally over the next few months, but his coat looked nappy and he never regained the weight he had lost. The reason became clear in late November, when the vet found an oral squamous cell carcinoma under his tongue. He was euthanized on 12/7/2021, shattering our hearts into a million pieces. So it's been a rough year.

The good news for Chispa is that her IBD has been completely controlled with 5mg/day of prednisolone. Her weight has stayed consistent (she actually got too plump at one point), and I can't even remember the last time she vomited. The prescription renal diet seems to agree with her, but I know now that it's too high in carbs for a diabetic kitty. I'm hoping that she will be ok with the change in diet, especially since we've reduced her pred to 2.5mg/day.

I'll run up to CVS tomorrow morning and pick up the human glucometer and supplies. I'm just terrified of reducing her BG too much with the insulin once we switch to the lower-carb diet. So again, is it better to start the insulin immediately, then transition her diet -- or switch to the low-carb food first, then re-test in a week or so, before starting the insulin? I'll email the vet with this question as well, but she works Tues - Fri, so I won't get an answer for a few days.

Many thanks again,
Karen and Chispa

I'm so sorry to hear about Chulo ♥ I'm going to tag Wendy for you again
@Wendy&Neko

 

[Wendy&Neko]

You can't diagnose IBD via ultrasound alone. As you know, a biopsy is needed to differentiate from small cell lymphoma. Having said that, and depending what her heart is like, the vet may have chosen best guess. Has your kitty ever had a echocardiogram? A heart murmur by itself doesn't tell anything, there are some murmurs that are just caused by age and are benign. Prednisolone can also be contraindicated for some heart conditions, it was for Neko. She was on budesonide instead, a more locally acting steroid that often doesn't raise the blood sugars. Prednisolone will mask SCL for a while, until it doesn't. Neko never got special food for her GI disease or CKD, and kept eating what she was eating before, though I mixed up the proteins a bit. For small cell lymphoma, it doesn't matter what food you feed.

I wouldn't wait on a diet change to start insulin. High 400's means she needs insulin. As long as you are home testing, you can tell if her dose needs are less once you start the food change. I'd echo the others on "human meter". Our dosing methods were developed with human meters, the test strips are way cheaper, and a lot more available should you have a sudden need for them.

 

[Karen and Chispa (GA)]

Hi Wendy,

Thanks so much for your note and weighing in on the diet change. I went to CVS earlier today to buy a (human) glucometer but got so confused and overwhelmed that I ended up coming home and ordering the Relion meter that Sienne had recommended from Walmart online, along with the test strips and lancets. They should be here on Tuesday, and then we'll begin. My only concern about changing over to a low-carb diet is that her BG will go too low and I won't know how to safely and appropriately reduce the insulin. Maybe I'll wait until our follow-up visit with the vet before changing her diet.

Chispa has had two echocardiograms, one a year ago and the second last week. The report was four pages long, but the "executive summary" is that nothing has changed since a year ago, which is good, and that she should be ok for anesthesia (I asked specifically because she needs a dental cleaning). Were you asking in reference to pursuing a biopsy for IBD/SCL? Here's the thing: her GI issues have resolved so remarkably well on pred, and her many other issues are holding steady (there are even more that are not included in my signature because I ran out of room: I-131 thyroid treatment in Nov 2019, hypertensive retinopathy and partial vision loss in Feb 2020, and a second retinal detachment in Jan 2022, resulting in further vision loss, though she still has some) ... this little warrior has fought battle after battle, and I just don't want to add to her challenges by putting her through an invasive procedure with a long recovery time. I'm not even sure about the dental cleaning. It's a lot to sort out, needless to say.

 

[Wendy&Neko]

Were you asking in reference to pursuing a biopsy for IBD/SCL?

Good news the echos showed things are fine. And yes, I was asking regarding anaesthesia for biopsy. Prednisolone can indeed help with IBD and SCL for a long while. Unfortunately, with SCL at some point it can no longer do the job. I've heard someone compare SCL as a lymphocytes manufacturing plant. Pred battles the lymphocytes, but at some point the manufacturing plant puts out more than pred can consume. Chlorambucil (if SCL) is what's helps shut down the manufacturing plant. I belong to an SCL group where a lot of kitties have the surgery (mine was lucky enough to just need endoscopy), and it's not that long a recovery. But you do have to balance age of cat and other conditions when making the decision.

 

[Karen and Chispa (GA)]

I joined an SCL group last year around this time, likely the same one (Janet's, yes?). It was a source of deep, extensive knowledge and dedication to science, along with great kindness and compassion. But at the same time, I found it incredibly stressful to be told one thing in the group (you are doing your cat a disservice by not getting a biopsy) and something else from a very good vet that I had trusted for more than a decade (it is totally reasonable to treat with pred for as long as it controls the symptoms, and then with chlorambucil if/when it doesn't). I consulted with an internal medicine specialist as a "tie-breaker" and ended up not doing a biopsy on either cat. It wouldn't have changed anything for Chulo -- he got pred plus chlorambucil for five months, and then died of another cancer (OSCC) -- and for Chispa, the pred alone has worked wonders. I'm a big believer in gathering all the facts and then making a decision that feels right, and this one did -- but I also realize that in Chispa's case, plain old luck has certainly played a part.